Chest wall deformities
(Nayrin Sk , BPT 4th year, BIMLS)
Out Line
• What is Chest wall deformities & Chest wall
• Classification
• Pectus excavatum
• Pectus carinatum
• Poland’s syndrome
• Sternal cleft
• Jeune’s syndrome
• Aquired chest wall deformities
Chest wall deformity What is chest wall
A chest wall Deformity is a Chest wall or thoracic wall is
structural abnormality of the boundary of thoracic cavity,
the chest wall that can be which protects the vital organs
.range from mild to severe. in the area between neck and
. . the abdomen.
.
Cross section of normal chest
wall is elliptical in shape.
Classification
common chest Rare chest wall
wall deformities deformities
Pectus Pectus Poland’s Jeune’s Acquired chest
4
excavatum carinatum syndrome syndrome wall deformities Sternal cleft
Common chest wall deformities
Rare chest wall deformities
Sternal cleft
Poland’s syndrome
Acquired chest wall deformity
in ricket patient
Pectus excavatum
Definition:
Pectus excavatum or funnel chest describes a posterior depression
of the lower sternum and costal cartilage into the thoracic cavity
Pathophysiology:
• It is a sternocostal joint deformity
• Present with abnormal sternal depression
• Chest anteroposterior diameter will be decrease
Clinical features:
Symptoms : Signs:
• Exercise intolerance • Slouched posture
• Dyspnoea • Protuberant abdomen (for young children)
• Chest pain with or without exercise • Associated with scoliosis
• Palpitation • Sternal abnormalities (cup shaped appearance )
• Cosmetic appearance • Sternal torsion
Pectus excavatum
Investigation:
• Electrocardiography(ECG)
• Echocardiography
• Spirometry
• Chest X ray(AP and lateral view)
• Computer tomography or CT scan
Treatment:
Surgical procedure –
• Nuss procedure
• Minimally invasive repair
Non-surgical procedure –
• Vacuum bell device
Nuss procedure
Pectus carinatum
Definition:
Pectus carinatum or pigeon chest is a spectrum of anterior chest wall
anomalies characterised by protrusion of the sternum and adjoining
costal cartilages.
Pathophysiology :
• Impair sternocostal cartilage collagen arrangement
• Abnormal sternal protrusion
• Augmented residual lung volume
Clinical features:
• Exertional dyspnoea
• Decreased exercise tolerance
• Precordial chest pain
• Cosmetic deformity
• Sternal protrusion
Pectus carinatum
Investigation:
• X ray (PA and lateral view)
• CT scan
• Spirometry
Treatment:
Surgical procedure – Transverse osteotomy
Conservative method– External dynamic compression
brace system
Poland’s syndrome
• Absence of the sternocostal head of the
pectoralis major muscle.
• Absence of pectoralis minor muscle.
• Normal underlying ribs to complete
absence of anterior posterior of the 2nd-5th
ribs.
• Absence of costal cartilage.
Sternal cleft
• Sternal cleft is a rare congenital defect of the
anterior chest wall and is the result of a failed
midline fusion of the sternum.
• Because of this condition mediastinal viscera and
vessels are exposed to injury.
• There are some forms of sternal cleft ——
1) Superior sternal cleft 2) Inferior sternal cleft
3) Total sternal cleft 4) Subtotal sternal cleft .
Jeune’s syndrome
• Narrow rigid chest and multiple cartilage
anomalies.
• Bell-shaped thorax and protuberant
abdomen.
• Short,stubby extremities with relatively short
wide bones.
• Pelvis is small with square iliac bone.
• Involves variable degree of pulmonary
impairment.
• Patient died of respiratory insufficiency .
Acquired chest wall deformities
Acquired deformities can be grouped
under——
1. Metabolic disorder like ricket
2. Trauma like road traffic accident
(RTA)
3. Surgical changes like
thoracotomy
4. Infections like rib osteomyelitis
Rib osteomyelitis of a child
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